Strength of Association between Coronavirus Disease 2019 and Neurological Disorders in Children: A Case-Control Study.

Evidence suggests potential neurological complications of Coronavirus Disease 2019 (COVID-19), particularly in adults. While case series have hinted at associations between COVID-19 and neurological disorders (NDs) in children, the extent of this link remains unclear. This study investigates temporal trends in NDs during the pandemic and assesses their potential association with COVID-19 infection in children. We analyzed national Thai hospitalization data (2017-2022) for children under 18 with specific NDs (acute transverse myelitis, central nervous system demyelination, neuromyelitis optica, optic neuritis, polyneuropathy, stroke). An interrupted time series analysis was employed to identify changes in the incidence trends of NDs following the declaration of the COVID-19 pandemic. A matched case-control analysis was conducted using data specific to the Thai COVID-19 outbreak period. This analysis aimed to estimate the association between recent/concurrent COVID-19 infection and NDs in children. A propensity score matching on age group, sex, and month of admission was performed before conducting logistic regression. From 2017-2022, 1,721 children admitted with NDs (2,474 admissions), with a male predominance (55%) and average age of 10.6 years. Significant slope change was observed in optical neuritis trends coinciding with the third COVID-19 wave. The case-control analysis included 468 cases and 2,340 controls. Children with NDs had a significantly higher prevalence of recent/concurrent COVID-19 (matched odds ratio: 1.95, 95% confidence interval: 1.21-3.16). Subgroup analysis revealed an association between stroke and recent/concurrent COVID-19 (matched odds ratio: 3.05, 95% confidence interval: 1.3-7.16). Thus, this study suggests an association between recent/concurrent COVID-19 and NDs, especially pediatric stroke.

Predicting Endometrial Hyperplasia and Endometrial Cancer on Recurrent Abnormal Uterine Bleeding.

OBJECTIVE: To develop predictive models for endometrial hyperplasia and endometrial cancer in patients with recurrent abnormal uterine bleeding (AUB). METHODS: This retrospective cohort study analyzed patients with recurrent AUB who had previous endometrial sampling that showed benign results between January 2013 and December 2021. A model was constructed from the significant factors associated with endometrial hyperplasia and endometrial cancer using multivariate logistic regression. Risk scores were calculated from the log odds of each significant predictive factor and were subsequently subcategorized into risk groups. The overall performance and internal validation of the model were assessed with the area under the receiver operating characteristic curve (AUC) and bootstrap methods. RESULTS: Of the total 456 patients with recurrent AUB, endometrial hyperplasia and endometrial cancer were detected in 8.3% and 2.2% of cases, respectively. The average interval between the first and second endometrial samplings was 25.1 months. Factors significantly associated with endometrial hyperplasia and endometrial cancer included age older than 45 years (odds ratio [OR] 2.86, 95% CI, 1.31-7.03), nulliparity (OR 3.50, 95% CI, 1.76-6.85), a history of endometrial polyp (OR 3.69, 95% CI, 1.93-7.05), and an interval of less than 12 months between sampling (OR 2.36, 95% CI, 1.25-4.42). Predictive factors were scored and categorized into three groups: 0-3, 5-8, and 9-11 points. The corresponding risks for endometrial hyperplasia and endometrial cancer in these groups were 4.7%, 15.5%, and 57.1%, respectively. The AUC was 73.1%, with a mean absolute error of 0.01. CONCLUSION: Endometrial hyperplasia and endometrial cancer occur at low incidence among one-fifth of patients with AUB who experience recurrent bleeding. Older age, nulliparity, a history of endometrial polyps, and an interval of less than 12 months between samplings are predictive factors for endometrial hyperplasia and endometrial cancer in this cohort.

Factors associated with burnout among dentists in public hospitals, southern Thailand.

Background/purpose: Physician burnout is now a public health crisis and dentist is a stressful professional health occupation. The purpose of this cross-sectional study was to determine the level of burnout and related factors among 423 Thai dentists working in public hospitals, southern Thailand. Materials and methods: A self-administered questionnaire was collected through an online platform and included 5 parts: general information, work information, 22-item Maslach Burnout Inventory-Human Services Survey (MBI-HSS), 23-item Thai Effort-Reward Imbalance Questionnaire (Thai ERIQ), and the Utrecht Work Engagement Scale-9 (UWES-9). The data were analyzed for descriptive statistics - frequency, percentage, mean, standard deviation - and inferential statistics using binary logistic regression. Results: The prevalence of medium to high level of burnout were 45.8%, 44.3%, 4.0% for emotional exhaustion, depersonalization, and low personal accomplishment, respectively. Regarding to the multivariate analysis, the statistically significant factors associated with emotional exhaustion were age, work engagement, workplace relationship, work effort, work reward, grade point average, and workplace consultant. The factors associated with depersonalization were age, work engagement, workplace relationship, work effort, and job reselection. The factors associated with personal accomplishment were age, work engagement, work reward, and level of workplace. Conclusion: In this study, we identified several factors that can be modified to reduce the risk of burnout among dentists in Thailand.

The Geriatric Depression Scale Predicts Glycemic Control in Older Adult with Type 2 Diabetes Mellitus: A Longitudinal Study.

The presence of comorbid depression and diabetes is associated with worse glycemic control, higher complication and greater mortality risk than expected by each condition alone. The association between various levels of severity of depressive symptoms and glycemic control over time among type 2 diabetic older patients was unclear. This study aimed to investigate a longitudinal association between depression and HbA1c among type 2 diabetic older patients. Type 2 diabetes patients aged 60 years and above with normal cognition were recruited from the outpatient department from 1 June 2020 to 1 July 2021. The Thai Geriatric Depression Scale (TGDS) and HbA1c were assessed at five time points (baseline and every 12 weeks) for 1 year. A linear mixed effect model was used. Of the 161 enrolled participants, 146 completed the study. At baseline, 14% were susceptible to depression or having depression (TGDS score 6 and above), and there was a significant correlation between HbA1c and depression (r = 0.26, p ≤ 0.01). The longitudinal analysis indicated that TGDS was a significant predictor of HbA1c in the next visit, and the relationship was J-shaped. A TGDS below 5 was associated with decreasing HbA1c in the next visit, but the association became positive at a TGDS score at 5 or higher. The presence of significant symptoms of depression was associated with glycemic control in the next 3-month interval OPD visit event, although major depressive disorder has not yet been established.

Factors influencing precautions against antineoplastic drug exposure among nurses and nurse assistants in Thailand.

BACKGROUND: Antineoplastic drugs (AD) are important chemical risks for healthcare workers. Precautions against AD exposure include the use of appropriate personal protective equipment (PPE). Evaluation of PPE usage during patient care processes has not been reported in Thailand. We aimed to evaluate the level of PPE usage and factors predicting PPE usage among nurses and nurse assistants in Thailand. METHODS: A cross-sectional survey was conducted in a university hospital and two general hospitals. The questionnaires covered demographic characteristics, self-reported use of PPE and 7 predictive factors. Mixed-effects modeling was used to determine the association between standardized score of predictive factors and PPE usage score. RESULTS: The response rate was 78.6% and 884 participants were left for analysis after data cleaning. Among nurses (n = 499), higher PPE usage score was associated with self-efficacy (ß = 0.28, 95% CI 0.21, 0.34), workplace safety climate (ß = 0.27, 95% CI 0.20, 0.34), and conflict of interest (ß = - 0.07, 95% CI - 0.14, - 0.01). Among nurse assistants (n = 385), higher PPE usage score was associated with self-efficacy (ß = 0.27, 95% CI 0.18, 0.36), interpersonal influence (ß = 0.14, 95% CI 0.04, 0.24), workplace safety climate (ß = 10.29, 95% CI 0.19, 0.38), and conflict of interest (ß = - 0.14, 95% CI - 0.24, - 0.03). CONCLUSIONS: Several factors were associated with PPE usage among nurses and nurse assistants. Improved PPE usage against AD can be promoted through interventions that modify those factors.

Performance of the unilateral AV/IVC index in primary hyperaldosteronism subtype prediction: A validation study in a single tertiary centre.

BACKGROUND: Failure of cannulation of the right adrenal vein is frequent during AVS for investigation of primary aldosteronism (PA). The aldosterone:cortisol ratio of either adrenal vein compared with the inferior vena cava (AV/IVC index) has been proposed to differentiate between unilateral and bilateral disease, and aid in lateralization of unilateral disease. METHODS: Sixty-two patients with unilateral or bilateral PA identified by either successful bilateral (45 patients) or unilateral (17 patients) adrenal vein cannulation, and with biochemical remission following surgery were enrolled into the analysis. The diagnostic performances of the previously identified AV/IVC index cut-offs of ≥5.5 to predict ipsilateral disease and ≤0.5 to predict contralateral disease were validated using data from the entire cohort. RESULTS: Fifty-three patients had unilateral PA and 9 patients bilateral PA. The area under ROC curve (AUROC) of the AV/IVC cut-off ≤0.5 for identifying unilateral aldosterone secretion from the contralateral adrenal was 0.95 (95% CI; 0.88-0.99), whereas the AUROC of the AV/IVC cut-off ≥5.5 for identifying unilateral aldosterone secretion from ipsilateral adrenal was 0.96 (95% CI; 0.92-0.99). The AV/IVC index cut-off value of 0.5 had 93% sensitivity and 91% specificity, and the AV/IVC index cut-off value of 5.5 had 21% sensitivity and 100% specificity. The optimal AV/IVC cut-offs to achieve 100% specificity for our cohort were >2.4 and <0.1 to predict ipsilateral and contralateral disease. CONCLUSION: Our data confirm that the AV/IVC index is a potential tool for subtype classification and lateralization in patients with PA in the setting of failed bilateral, but successful unilateral, adrenal vein cannulation during AVS.

Noise exposure assessment in a dental school.

OBJECTIVES: This cross-sectional study was performed in the Dental School of Prince of Songkla University to ascertain noise exposure of dentists, dental assistants, and laboratory technicians. A noise spectral analysis was taken to illustrate the spectra of dental devices. METHODS: A noise evaluation was performed to measure the noise level at dental clinics and one dental laboratory from May to December 2010. Noise spectral data of dental devices were taken during dental practices at the dental services clinic and at the dental laboratory. A noise dosimeter was set following the Occupational Safety and Health Administration criteria and then attached to the subjects' collar to record personal noise dose exposure during working periods. RESULTS: The peaks of the noise spectrum of dental instruments were at 1,000, 4,000, and 8,000 Hz which depended on the type of instrument. The differences in working areas and job positions had an influence on the level of noise exposure (p < 0.01). Noise measurement in the personal hearing zone found that the laboratory technicians were exposed to the highest impulsive noise levels (137.1 dBC). The dentists and dental assistants who worked at a pedodontic clinic had the highest percent noise dose (4.60 ± 3.59%). In the working areas, the 8-hour time-weighted average of noise levels ranged between 49.7-58.1 dBA while the noisiest working area was the dental laboratory. CONCLUSION: Dental personnel are exposed to noise intensities lower than occupational exposure limits. Therefore, these dental personnel may not experience a noise-induced hearing loss.